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Low back injuries in athletes can be classified into three diagnostic categories: disk problems, hypomobility/hypermobility problems, and muscular problems. Various strategies have been presented for the identification and treatment of these disorders. The translation of rehabilitation procedures to an athletic population including resumption of training and competition have been discussed.
A case-control study of occupational injuries sustained by 914 male hourly workers employed in two Tenneco manufacturing divisions in 1987 was undertaken to examine the association between occupational and non-occupational injuries. Its aim was to evaluate whether employees who experienced a work-related injury were more likely to have sustained a previous non-work-related injury compared to individuals who did not experience a work-related injury. A statistically significant association between occupational injuries and past non-occupational injuries was seen when all workers compensation (WC) claims were analyzed (OR = 1.41) and when claims involving indemnity for lost time were analyzed (OR = 1.82). In addition, both workers who had occupational low-back injuries and workers who had occupational non-low-back injuries also had significantly higher risks of such injuries from a non-occupational origin (OR = 1.91 for low-back injuries and OR = 1.44 for non-low-back injuries). The findings suggest that elements other than workplace hazards (such as life-style and physical and psychological factors) may predispose an individual to both occupational and non-occupational injuries.
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AIM: This paper reports a study that aimed to evaluate the workload, to identify problems leading to the higher incidence rate of work-related low back injury among nurses in the orthopaedic and intensive care unit departments of the hospital, and to gather information about improvements that the nurses would like in the workplace. BACKGROUND: The literature shows that low back injuries are common among nurses, and intervention programmes are needed to address this problem. METHOD: The hospital injury records were examined in a retrospective study. In addition, a validated questionnaire was administered between January and May 2005 to 47 nurses (23 orthopaedic and 24 intensive care nurses). The questionnaire contained questions on workload, history of back injuries, problems, possible solutions and psychophysical measures of exertion. FINDINGS: The life-time incidence and point prevalence of low back pain were 65% and 30%, respectively, in orthopaedic nurses, and 58% and 25%, respectively, in the intensive care nurses. The mean weight handled was reported to be 47 +/- 30 kg by the orthopaedic nurses and 26 +/- 10 kg by the intensive care nurses. The low back scored highest for body-part discomfort - 4.6 and 4.0, respectively, on a 10-point scale. The rate of perceived job exertion was 6.7 +/- 1.8 (very strong), and 5.8 +/- 1.9 (strong) on Borg's 10-point scale. The total effort required by the job, rated on Visual Analogue Scales, was 67 +/- 14% and 68 +/- 15% of the maximum, respectively. The Borg scores and the total effort according to the Visual Analogue Scale, and the Borg scores and force effort on the Visual Analogue Scale were moderately correlated (r = 0.53, P < 0.01 for both comparisons). CONCLUSION: The methodology proposed here is practical for job evaluation and to design a participatory ergonomic intervention aiming at reducing low back injuries in nursing jobs. There are workload differences between nursing jobs. Lifting devices, biomechanical training, bigger rooms, adequate set-up and additional staff are suggested improvements.
OBJECTIVES: This pilot study explored a broad range of work-related outcomes for occupational low back injuries. METHODS: A model of occupational outcomes and a survey instrument were developed on the basis of interviews, expert opinion, and literature reviews. New Hampshire workers who had an occupational back injury a year before the study were sampled from first reports of injury and sent a mailed survey about their postinjury experiences and related factors. RESULTS: Of 251 randomly selected cases, a valid address could be identified for 121, and 99 patients responded. Almost 60% of the respondents had lost 1 week of work or more. At 1 year after injury, half of the respondents had returned to their preinjury job and employer, and 20% were unemployed, half of them because of the injury. Most working respondents reported no decrease in their work capacity. However, 68% still had pain exacerbated by work, and 47% worried that their condition would worsen with continued work. Reinjury occurred in 42% of the respondents. The work-related outcome measures were largely independent of each other. Exploratory multivariate analyses demonstrated unique patterns of factors associated with each outcome. Reinjury risk was significantly greater in respondents whose employers offered accommodations or whose postinjury jobs had greater ergonomic risk. The small sample size limited the ability to achieve statistically significant results in multivariate analyses. CONCLUSIONS: Simply measuring return to work did not appear to capture the full range of job-related consequences from occupational back injuries in this pilot evaluation. Timing of return to work, occupational ergonomic risks, and appropriate job modifications appeared to be particularly important in a safe return to the job after an occupational low back injury. Results suggest opportunities to address risk factors that may improve work outcomes.
Subjective recall of symptoms among nonlitigants with closed-head and back injuries and non-injured participants with high and low levels of life stressors was evaluated. All participants completed a demographic questionnaire, the Brief Symptom Inventory, and a symptom checklist. Recall of symptoms by participants with closed-head and back injuries was consistent with perceptions of being worse now than they were before their injuries. The results further suggest that these participants tend to overestimate the actual degree of change that has taken place by recalling fewer pre-injury symptoms than control participants. In addition, participants with closed-head injuries, but not with back injuries, showed significantly higher levels of symptom endorsement now than controls.
A major new study conducted by the UCLA School of Public Health has bolstered the claim that back support devices reduce low-back injuries. The study involved nearly 36,000 employees at Home Depot stores in California who logged 101 million work hours from 1989 through 1994. The company implemented mandatory wearing of belts in early 1990, and the study's authors reported that the workers' rate of acute low back injuries fell from 30.6 per million hours before implementation to 20.2 per million hours. UCLA Professor of Epidemiology Jess F. Kraus, the study's lead author, told The Wall Street Journal. "The study found a pretty big effect with a simple countermeasure. It is pretty hard to argue that it is a chance phenomenon." Kraus, who is the director of UCLA's Southern California injury Prevention Research Center, began his research by visiting 30 Home Depot stores to see whether employees were wearing the belts consistently. Compliance with the mandatory policy was quite high overall-above 98 percent, as calculated during an unannounced walk-through of all 77 stores in late 1993 and early 1994, according to the study. Back support manufactures hailed the Home Depot study as the largest long-term epidemiological study yet undertaken of the supports. It is proof, they said, that back supports are effective personal protective equipment-a contention at odds with the position of NIOSH the National institute for Occupational Safety and Health. In 1994, NIOSH reviewed the scientific literature and concluded there was not enough evidence to recommend that the supports be worn by uninjured workers. Sales plunged after NIOSH released its findings, according to the manufactures. The UCLA researchers found that low-back injuries declined in workers of both sexes, in younger workers as well as those older than 55, and among those with low levels of lifting as well as those with higher levels. The researchers concluded that mandatory use of back supports significantly reduces acute low-back work injuries. Low-back injuries account for one-fourth of all workers' compensation claims paid by U.S. employers-$11 billion in 1990 alone. NIOSH's ergonomic coordinator, Lawrence Fine, told The Journal, "for many companies this is the largest health and safety issue they are wrestling with." NIOSH has embarked on its own, smaller study of back supports' effectiveness among Wal-Mart workers.
Back injuries are one of the most significant industrial liabilities, resulting in increased absenteeism, costly medical expenses, and often employee disability. The authors present a reliable and valid back health risk assessment tool to measure predisposition for back injuries. The tool was developed with the collaboration of members of a local constituent association. The tool can be implemented by routine interviews with workers. Occupational health nurses can use the tool to diagnose and possibly alleviate back injuries in workers. Use of the tool will help to further define the characteristics for the potential for back injury.
Occupational illnesses and injuries are common problems facing workers and employers. The purpose of this study was to determine the nature and extent of illnesses and injuries among hospital workers in Ohio. All workers' compensation claims for 22 hospitals in Ohio during the period 1993-1996 were reviewed. The majority of the claims were for sprain and strain injuries. Most of the claims were approved. Back injury was the leading cause of injury in both genders, and females reported a significantly higher percentage of back injuries. The incidence rates for injuries and illnesses were lower than national rates for other industries. Generally, there was a downward trend in the number of claims during the study period. A negative linear trend in injury rates by hospital size was detected. Our findings suggest the need for safety programs, especially in smaller hospitals, with the goal of preventing sprain and strain injuries.
BACKGROUND AND PURPOSE: With the current interest in stability training for the injured low back, the use of labile (movable) surfaces, underneath the subject, to challenge the motor control system is becoming more popular. Little is known about the modulating effects of these surfaces on muscle activity. The purpose of this study was to establish the degree of modulating influence of the type of surface (whether stable or labile) on the mechanics of the abdominal wall. In this study, the amplitude of muscle activity together with the way that the muscles coactivated due to the type of surface under the subject were of interest. SUBJECTS: Eight men (mean age=23.3 years [SD=4.3], mean height=177.6 cm [SD=3.4], mean weight=72.6 kg [SD=8.7]) volunteered to participate in the study. All subjects were in good health and reported no incidence of acute or chronic low back injury or prolonged back pain prior to this experiment. METHODS: All subjects were requested to perform 4 different curl-up exercises-1 on a stable surface and the other 3 on varying labile surfaces. Electromyographic signals were recorded from 4 different abdominal sites on the right and left sides of the body and normalized to maximal voluntary contraction (MVC) amplitudes. RESULTS: Performing curl-up exercises on labile surfaces increased abdominal muscle activity (eg, for curl-up on a stable surface, rectus abdominis muscle activity was 21% of MVC and external oblique muscle activity was 5% of MVC; for curl-up with the upper torso on a labile ball, rectus abdominis muscle activity was 35% of MVC and external oblique muscle activity was 10% of MVC). Furthermore, it appears that increases in external oblique muscle activity were larger than those of other abdominal muscles. CONCLUSION AND DISCUSSION: Performing curl-ups on labile surfaces changes both the level of muscle activity and the way that the muscles coactivate to stabilize the spine and the whole body. This finding suggests a much higher demand on the motor control system, which may be desirable for specific stages in a rehabilitation program.
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OBJECTIVE: To determine whether narrative text in safety reports contains sufficient information regarding contributing factors and precipitating mechanisms to prioritize occupational back injury prevention strategies.Design, setting, subjects, and MAIN OUTCOME MEASURES: Nine essential data elements were identified in narratives and coded sections of safety reports for each of 94 cases of back injuries to United States Army truck drivers reported to the United States Army Safety Center between 1987 and 1997. The essential elements of each case were used to reconstruct standardized event sequences. A taxonomy of the event sequences was then developed to identify common hazard scenarios and opportunities for primary interventions. RESULTS: Coded data typically only identified five data elements (broad activity, task, event/exposure, nature of injury, and outcomes) while narratives provided additional elements (contributing factor, precipitating mechanism, primary source) essential for developing our taxonomy. Three hazard scenarios were associated with back injuries among Army truck drivers accounting for 83% of cases: struck by/against events during motor vehicle crashes; falls resulting from slips/trips or loss of balance; and overexertion from lifting activities. CONCLUSIONS: Coded data from safety investigations lacked sufficient information to thoroughly characterize the injury event. However, the combination of existing narrative text (similar to that collected by many injury surveillance systems) and coded data enabled us to develop a more complete taxonomy of injury event characteristics and identify common hazard scenarios. This study demonstrates that narrative text can provide the additional information on contributing factors and precipitating mechanisms needed to target prevention strategies.
Back and leg complaints were studied by using a questionnaire and medical examination in 183 male conscripts and relating the results to background variables, anthropometry, the isometric strength of large muscle groups, and endurance running. A history of sciatica was reported by 8%, lumbago by 13%, back injury by 13% and low back insufficiency by 63%. Weak trunk extensors were associated with a history of sciatica, weak trunk flexors with back injuries and with current backache at work/exercise. Weak leg extensors showed associations with a history of low back insufficiency and of sick leave due to the back and with current hip pain. Men with a history of lumbago and of hip and knee complaints performed poorly during 12 min of running. Back and leg complaints were more frequent in men with high socio-economic status, who engaged in little physical activity, or who were obese. The questionnaire and strength measurements proved suitable for studying low back syndrome in its early stages.
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According to the Labor Standard Bureau of Japan, accidental back injuries accounted for about 60% of all occupational injuries and diseases in the last decade. The Ministry of Labor issued guidelines to prevent low back injuries in 1994 to address the problem. The use of back belts is recommended for some special working conditions but details on its proper use were not given. This study was planned to evaluate a newly developed back belt and was done at an express package delivery company where the incidence of low back injury was high. The BackTracker was used to evaluate the effect of the back belt on the range and velocity of torso motion. The results indicated that there were no significant differences in the range of motion (ROM) during flexion/extension, lateral bending, and rotation between with and without the belt. The maximum angular velocity (MAV) of flexion decreased significantly (average decrease: 30 +/- 28.3 degrees/sec) when the back belt was worn. The MAV of extension with belt showed a decreasing tendency though not significant. No notable trends were observed in the MAV, during lateral bending and rotation of the subjects while wearing and not wearing the belt. The results also indicated that the back belt affected differently the torso motion of each subject. This study suggested that this back belt could be useful for tasks with high velocity of flexion/extension and that proper instruction on the use of the back belt is needed for each worker.
Back injury is widely considered an occupational hazard of nursing work. Manual handling of patients has been implicated in the development of back injury in nursing. Legislation has been in place in the UK since 1992 that should have addressed factors implicated in the development of back injury, such as manual handling of patients. Nurses' patient handling practices have been slow to change in line with this legislation. This can be explained in part by a lack of training and resources required for change. However, nurses' attitudes and beliefs about patient handling, and the culture into which new nurses are socialized, may play a significant role in hindering changes in patient handling practice.
Low back injury is the leading cause of compensable injury. A National Health Objective for the year 2000 is to increase to at least 50% the number of worksites offering back injury protection programs. The 6 week Back School intervention included exercise and education. A portion of the sample of 74 back injured municipal employees also was assigned randomly to a counseling intervention. Pre-intervention and post-intervention testing revealed significant posttest increases in back strength and flexibility. Significant improvements also were noted in psychological well being, depression, anxiety, and perceptions of pain. No significant differences were found, on any of the measures, between employees who did and who did not receive the counseling intervention. Methodological concerns relate to the possibility of sampling bias and instrumentation. Future research with control groups is needed, as well as the testing of interventions that may be both effective and require less work release time.
This study assessed the immediate effects of the U.S. Navy's Healthy Back Program in changing knowledge about back injury prevention. The prevalence of back problems among incoming recruits and correlates of back pain also were examined. Intervention recruits (n = 1,772) received the Healthy Back Program presentation, then completed a questionnaire. Control subjects (n = 1,658) completed an identical questionnaire but received no presentation. Intervention recruits scored significantly higher on back knowledge (67%) than controls (50%). About 41% of all recruits had experienced a back problem, 27% reported at least one back problem within the past year, and 11% reported back pain during recruit training. Lifting, sports participation, and bending were the leading causes of previous back problems. Better self-reported health and fitness were associated with fewer low back problems.